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2018 Legislative Spotlight Opioids in the Crosshairs and a Limited PTSD Breakthrough

By Michelle Hopkins | 08/13/2018

This article is based on information from the National Council on Compensation Insurance.

In the first half of 2018, state legislatures enacted 76 bills related to workers’ compensation; states adopted 83 new regulations, with medical cost management as a dominant theme.

Arizona, Hawaii, and Indiana Take Aim

Nearly 20 states considered legislation to address aspects of prescription drugs in workers’ compensation, including drug formularies, choice of pharmacy, prescription drug monitoring programs, and pharmacy benefits management.

The national opioid challenge remained in the states’ crosshairs. Arizona tightened requirements on prescribing, monitoring, and dispensing opioids. In Hawaii, healthcare providers in the workers’ compensation system who are authorized to prescribe opioids must adopt and maintain written informed consent policies when there is an elevated risk of dependency. 

Indiana limited workers’ compensation reimbursement for “N” drugs, or extended-release opioids, while Kentucky addressed the need for more guidelines related to opioid use for chronic pain. New York approved the presumption of compensability when a worker – previously prescribed opioids for a workplace injury – dies from an opioid overdose.

New York and Hawaii were two of the six most active states in considering new workers’ compensation-related legislation. Together with Missouri, New Jersey, Florida, and West Virginia, these states introduced 21 or more bills each on workers’ compensation issues.

Federal Law Overrides States

Two states – Louisiana and Maine – reaffirmed that employers and insurance carriers are not required to pay for or reimburse costs associated with a drug that is listed on Schedule I of the federal Controlled Substances Act, despite its having gained traction for legalization in many states. Schedule I drugs are illegal based on the federal law’s finding that there is a high potential for abuse, no currently accepted medical use, and a lack of accepted safety for use under medical supervision.

The Louisiana declaration was issued in state legislation, while in Maine, the State Supreme Court said employers and insurance carriers cannot be forced to pay these reimbursements.

Emotions Rise: Workers Comp for PTSD-Stricken First Responders

Since the Sandy Hook killings in 2012, Connecticut has sought approval of workers’ compensation benefits for first responders diagnosed with post-traumatic stress disorder (PTSD).

A firestorm of opinion, in Connecticut as well as other states, has been fanned by at least three factors: uncertainty over the likely total cost of claims filed with city and county governments; payment of benefits for lost wages (indemnity), not just medical costs; and debate over how to determine whether a PTSD diagnosis stems from work and to what degree.

By the end of 2017, Colorado, Texas, and Vermont had authorized workers’ compensation indemnity benefits for first responders with PTSD, while South Carolina offered an alternative: a $500,000 set-aside fund to help first responders recover from trauma. This effort will be reexamined and results assessed in 2019.

So far in 2018, numerous states have considered workers’ compensation for first responders with PTSD, including Arizona, Kentucky, Minnesota, Missouri, Ohio, South Carolina, and West Virginia. New Hampshire voted to study the increase of PTSD among first responders. (Both New Hampshire and Hawaii acted to make it easier for firefighters with cancer to receive workers’ comp payments.)

Two states have newly approved paying lost wages to first responders with PTSD – Florida and Washington – however, eligibility in Washington is tightly drawn.

The Washington law applies to firefighters, paramedics, and police officers, and first responders must have served a minimum of 10 years before PTSD manifested to be eligible. PTSD claims also must not be related to any disciplinary action, demotion, termination, or similar action.

What It Means to You

Workers’ compensation issues are continually shifting and erupting in hotspots of emerging issues. Top employers know it’s unwise to remain in the trenches focused solely on the familiar traditional issues. Each year, state legislatures consider thousands of proposed bills, and their actions frequently are the first red flag of the next new challenge in occupational health.

Concentra is your partner on the leading edge of workers’ compensation and occupational health. You can expect more “trending issues” articles like this. We are committed to giving you the information you need to know. We encourage you to contact a Concentra representative to learn many more ways we are helping you stay ahead of the mainstream.

*This document is an overview and does not constitute legal or medical advice. Employers should always consult with their legal counsel and human resources professionals.